Laserfiche WebLink
TRACY TRUCK STOP 209 e32 6807 04/06/04 01:09pm P. 012 <br />TSC 1000 Leak Ditector Tester <br />DATA COLLECTION AND REPORT FORM <br />Facility Name: <br />Leak <br />Detector <br />Model <br />Serial <br />Number <br />Facility Address: <br />S-"9 <br />PSI <br />0, <br />Flow <br />Rate <br />at 10 PSI <br />Pass <br />or <br />Fail <br />Facility Phone: 0-., <br />Test Date: '5/ <br />Test Contractor: <br />Address:�-Z- <br />'pry' <br />Contractor Phone #: <br />Product <br />Leak <br />Detector <br />Model <br />Serial <br />Number <br />Line <br />PSI <br />S-"9 <br />PSI <br />slow <br />Flow <br />PSI <br />Flow <br />Rate <br />at 10 PSI <br />Pass <br />or <br />Fail <br />3 <br />Test <br />Technician: <br />Signature: /4" <br />Date: -I Time- i (,,o <br />Comments- h/ (-1 -14-, Fc C 0v, 6 <br />